Strategic Goal: Democratic Transition

To improve the legislature's ability to make decisions based on independent and sound policy research, USAID has worked with the Congressional Research Service (CRS) to assist Romanian parliamentarians through training programs and give them greater access to information.

Ongoing USAID-funded municipal infrastructure projects in three cities dealt with customer service and also with management improvements and increased reliability of services. These activities helped reduce customer service backlogs in requests for water, sewage, and heating services by 35, 59 and 43%, respectively. Furthermore, the EBRD proposed loan for $65 million will be financing infrastructure improvements in five cities. In two of these cities, Brasov and Craiova, USAID, through the International City Management Association (ICMA), is directly assisting with the implementation of infrastructure development activities of this loan program.

In FY 1997, a more targeted program in the area of democratic transition will be maintained in order to foster increased decentralization of government towards the municipal and county level, and foster the development of Romanian non-governmental organizations (NGOs).

As part of a program directed at housing and urban improvements, USAID has implemented financial management, public budgeting, and water utility management programs. As a result of these initial successes, a Public Administration program initiated in 1995 in five initial cities will be expanded to five more. The program focuses on basic public management, economic development, and public participation.

The Rule of Law program offers technical assistance to the School of Magistrates and the Romanian bar associations and provides comments on draft laws. Emphasis will continue on Romania's business-related body of law including intellectual property protection, bankruptcy law, and international joint ventures.

Strategic Goal: Social Stabilization

Through the U.S. Department of Labor (DOL), USAID is supporting implementation of the Employment and Social Protection Project. DOL technical assistance for employment services is being coordinated with those of other bilateral donors, notably Germany.

Some of USAID's programs have a direct aim of reducing human suffering and improving long-term prospects for the disabled. Results include: 1224 institutionalized children reunited with their families, 65 handicapped or abandoned children moved from institutions to foster or group homes, and over 450 children adopted either domestically or abroad.

The USAID program also helped reduce health risks. For example, regulatory authorities and communityrepresentatives have worked together to improve worker safety in Zlatna, site of an outdated copper smelter responsible for heavy metal contamination and sulfur dioxide emissions.

U.S. technical assistance has supported three key components of the World Bank Health Rehabilitation Project. First, a USAID grant to UNICEF for Hepatitis B vaccinations directly leveraged the inclusion of a $15 million vaccination program in the World Bank project. Second, the U.S. Centers for Disease Control (CDC) provided training and advice in family planning logistics management, helping the GOR Ministry of Health (MOH) and the National Pharmacy to better implement a large World Bank-financed contraceptive commodity distribution program. Third, ongoing assistance to regional hospitals, chosen as test sites for health finance and management reform, is laying the groundwork for an entirely new system of payment for health services.

USAID strategy will continue to pursue key social service restructuring opportunities, moving beyond earlier service delivery programs in family planning and help for institutionalized children to address broader constraints in the health and social service delivery systems. An effort will be made to increase the role of private pharmacies in the delivery of contraceptives and to expand the general awareness of modern contraceptives. Health management training will build the human resources necessary to better manage the shift to primary health care and a diagnostic related cost (DRG) system will be introduced to allocate scarce health resources more rationally. The health program will support Romania's health reform law in key areas.

Strategic Goal: Cross-cutting and Special Initiatives

USAID funds a cross-cutting training program which offers training opportunities in the United States for Romanians in a number of key sectors and areas which support the strategic objectives of the USAID program.

Purpose: Increased soundness of fiscal policies and fiscal management practices.

Background: The era of Central Planning ensured that Romania inherited an antiquated set of fiscal policies and programs. Up until 1990, essentially all enterprise was state-owned and there was no individual income tax. Since 1990, there has been an explosion of privately owned companies (600,000) and a personal income tax has been introduced. It has become essential that the Government continue to modernize its fiscal policies, forecasting capabilities and cash management practices.

USAID Role and Achievements to Date: USAID-funded advisors have made major contributions to the formation of a new tax code which was recently enacted. They have also provided advice on how to better forecast cash requirements and improve treasury cash management practices.

Description: USAID financed treasury advisors are working with Ministry of Finance counterparts to ensure a more efficient revenue collection system and to shape more rational and transparent budgetary processes. With the new tax code in place, the emphasis has shifted to restructuring departments within the Ministry of Finance to improve line authority.

Other Treasury advisors have been instrumental in assisting the Ministry of Finance to develop forecasting techniques which have allowed the Ministry to better predict cash deficits and take advance action. Advisors are also assisting the Ministry and the National Bank in developing financing mechanisms on both the local and international markets.

Host Country and Other Donors: Ongoing efforts in this sector are coordinated with those of other donors including the Eastern European Assistance Program of the European Union (EU-PHARE) and the World Bank.

Beneficiaries: This effort seeks to benefit tax-paying Romanians at all levels.

Principal Contractors, Grantees or Agencies: U.S. Department of The Treasury.

Major Results Indicators*:

Awareness of budget deficit and amount of budget deficit
Amount of revenue available from cost efficient tax administration

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: Accelerated development and growth of private enterprises.

Background: Since 1990, Romania has embarked on the transition from a centrally planned to a free market economy. Progress has at times been slow but has quickened in the last two years. Currently, there are over 600,000 private enterprises in Romania and over 40% of GDP comes from non-government sources.

USAID Role and Achievements to Date: USAID programs have made major contributions in assisting small businesses to flourish. Because of the need for people in the judicial branch to learn more about the financial aspects of companies, USAID has embarked upon a program to train key personnel of this sector in interpreting company financial statements.

Description: USAID funded business development advisors continue to focus their efforts on providing assistance to companies that have demonstrated excellent growth potential in their sectors. The Romanian-American Enterprise Fund has also evaluated prospective investment projects and began its lending program during 1995.

Host Country and Other Donors: Ongoing efforts in this sector are coordinated with those of other donors including the United Nations Development Program (UNDP) program, World Bank and EU-Phare.

Beneficiaries: The direct beneficiaries of this assistance are the private entrepreneurs of small and medium sized businesses.

Principal Contractors, Grantees or Agencies: Washington State University, Citizens Democracy Corps, Volunteers in Overseas Cooperative Assistance (VOCA), Agricultural Cooperative Development International, Land O' Lakes, Aid to Artisans, Entrepreneurial Management and Executive Development (EMED), and Peace Corps. Romanian- American Enterprise Fund

Major Results Indicators:
Increases in company sales.
Number of business associations advocating on behalf of private sector initiatives, needs, and future growth requirements
Number of private sector businesses operating and generating employment

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: A competitive, market-oriented private financial sector.

Background: Development of the private financial sector has continued to accelerate. Legislation has been introduced in Parliament allowing for the privatization of state-owned banks. The first of these banks (the Romanian Development Bank) has already been identified.

The Bucharest Stock Exchange began trading operations in November 1995 and a separate over-the-counter (OTC) trading system is expected to be operational by mid-1996. The OTC system will be used to trade shares of the 3,900 companies that are under the mass privatization program and possibly Government securities.

USAID Role and Achievements to Date: USAID advisors have reviewed the draft bank privatization bill and recommended changes to it. All of these changes have been included in the Bill that is now in parliament. An expert has also been advising senior management of the Romanian Bank for Development on its privatization plans.

A major activity that USAID is undertaking is the development of an OTC trading system and all the components that go with it. The program is on track to be completed by mid-1996.

Finally, USAID is supporting a grass roots savings mobilization program which is intended to capture part of the liquidity that is not in the formal financial system. These funds could then be used for small business lending.

Description: A long term bank privatization Treasury advisor has worked extensively with the National Bank of Romania and the Council for Coordination, Planning and Economic Reform to develop a draft bank privatization law. The draft that has been submitted to parliament has had extensive input from this advisor and is acceptable to the World Bank.

In the capital markets area, assistance is being provided to strengthen the Romanian Securities and Exchange Commission, assist in the development of investment funds, develop an OTC trading system as well as all the back office operations (clearance, settlement and depository) that go with it.

A pilot program is underway to establish credit unions in private sector companies and capture some of the excess liquidity in the Romanian economy.

Host Country and Other Donors: Ongoing efforts in this sector are being coordinated with the World Bank, EU-Phare, the British Know How fund and Canadian technical assistance teams.

Beneficiaries: The Romanian population at large will have access to a much improved financial system.

Principal Contractors, Grantees or Agencies: U.S. Treasury, the World Council of Credit Unions, Coopers & Lybrand, INTRADOS, Financial Markets International and Booz Allen & Hamilton.

Major Results Indicators*:

Numbers of licensed viable private commercial banks
Volume of shares traded on over-the-counter markets

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose : A more economically sustainable and environmentally sound energy sector

Background : USAID provides assistance to the Government of Romania (GOR) in three critical areas of the energy sector: Power, Petroleum Refining and Petroleum Exploration and Licensing.

A main objective of the Power Sector Policy of the GOR is to provide reliable electricity supply to all Romania's people at least cost to the economy. The achievement of this objective is hampered by lack of a coherent legal and regulatory framework, inefficiencies of the sector institutions and lack of capital. To address these systemic problems, the GOR has decided to undertake a fundamental reform of the power sector that will bring about demonopolization of activities, and create conditions for the participation of publicly and privately owned companies in a competitive environment.

The refining sector has been beset by poor operational performance, extended downtime, losses and disregard for environment and energy conservation. As a first step towards developing such a strategy, the GOR intends to undertake a Study on Refining and Associated Petrochemical Sector Restructuring and Privatization.

As a condition to receiving World Bank assistance in the petroleum sector, and following technical assistance granted through USAID consultants, the Government of Romania agreed in 1993 to establish an independent National Agency for Mineral Resources (NAMR) to negotiate mineral rights and grant licenses for concessions and to oversee geological research. NAMR is responsible for administering a petroleum law that incorporates internationally recognized standards. The new law was approved by the Parliament in December of 1995. Previous USAID assistance identified the need for further assistance to NAMR, to become a fully operational, independent regulatory body.

USAID Role and Achievements to Date : USAID has been the key provider of technical assistance and program development support for over $500 million in lending from international financial institutions for energy sector programs.

- World Bank Petroleum Subsector Rehabilitation loan program signed and under implementation.

- Preliminary sector analyses and options studies for refinery and power sector restructuring programs completed and under review by the government.

- Long term consultant for oil and gas regulations arrived in Romania in October 1995 and have completed drafting regulations for well licenses, drilling, exploration, exploitation, and offshore and pipeline transportation systems.

Description : The Power Sector Study is to be carried out in two phases. The first phase, a diagnosis, should define the current constraints to the reaching of the GOR's policy objectives and will identify possible solutions for overcoming them. During this phase the USAID consultants review current options for restructuring, identify key issues associated with these options and analyze advantages and disadvantages of alternative options for consideration by the GOR. The second phase will build on the diagnosis and the GOR's decision with regard to the sector structure and ownership. In the second phase the consultants should provide the main elements for implementing the reform, including recommendations on detailed steps and schedules.

The Refining Study developed by the USAID Consultant will produce: 1) a restructuring strategy the refining and associated petrochemical sector based on a full review and detailed evaluation of the performance of each operating company in the sector; 2) a critical investment report needed to identify investments that hypothetically privatepartners/owners would need to undertake to optimize the performance of the plan; 3) privatization proposals of the refinery products retail marketing and service subsector and few large refinery-petrochemical operating companies.

Host Country and Other Donors: The Power Study is undertaken in partial fulfillment of the condition with the GOR and with respect to the World Bank, EBRD and EIB loan to the Electricity Utility RENEL. The loan for the power sector rehabilitation and modernization has an estimated value of $363,900,000 over a four year period.

The Refinery Study is undertaken in cooperation with the World Bank and EIB which granted a loan for the rehabilitation of the refining sector and promotion of private investment in the sector.

The assistance to NAMR is being provided in close cooperation with World Bank which granted a loan of $ 225,000,000 for the rehabilitation of the petroleum sector.

Beneficiaries: The primary beneficiaries of this assistance are the owners and suppliers of the respective organizations. All Romania will eventually benefit from a more efficient energy sector.

PrincipaL Contractors, Grantees or Agencies: The project is implemented by a team headed by the Bechtel Corporation, and comprised mainly of: Bechtel, Arthur Anderson, National Economic Research Associates, and Gaffney Cline.

Major Results Indicators*:

For Power Sector:
- Implementation of the strategy for option selected;
- New electricity law passed by the parliament.

For the Refinery Sector:
- Decision by GOR to implement the restructuring plan;

For NAMR:
- Publication and adoption by the agency of basic regulations for the
exploration, producing and pipeline industries

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: Increased, better informed citizens' participation in political and economic decision-making.

Background: USAID engages this issue in two significant areas; support for local NGO development and improved local public administration.

Six years ago, Romania was confronted by an influx of private groups all bringing emergency assistance. For the first time, Romanians heard of non-governmental organizations and tried to understand the concept. Initially, many officials were wary, refusing any involvement with NGOs, other than to form their own so they could access international funds. Then the pendulum shifted to attempting to control the NGO sector. Since 1994, however, there is broad recognition and support of the NGO sector in Romania, which has expanded beyond expectations.

In the area of public administration, decisions traditionally have been made and control exercised by the central government in Bucharest. Local authorities have restricted legal authority and even that authority is limited by central government control over the financial resources necessary to exercise even the limited authority the law provides. There are hopeful signs, however, as local officials are actively lobbying for increased levels of responsibility. A recently revised law on local government gives increased authority to municipalities.

USAID Role and Achievements to Date: USAID's "Democracy Network" program supports the emerging NGO sector in Romania, through: establishing linkages within the NGO community and program sectors; enhancing institutional effectiveness; fostering state, market and civil society collaboration; and increasing the access of Central and East European regional resources to Romanian NGOs. During the period July 1995 to February 1996, assessments were conducted throughout the country to identify NGOs with the potential to influence public policy in Romania and to make a preliminary assessment of their training and technical assistance needs. Of the 345 NGOs and 34 governmental organizations interviewed, 111 have qualified for participation in the "Democracy Network" program and 60 have further qualified to attend the NGO Management Workshop series. The first workshops in this series have been organized.

The Romania Public Administration Program began operation in October 1995. Its first public participation specialists began work in Romania at that time. As a result of their initial efforts, a citizen information center has been constructed, staffed and begun operation in Slobozia, sponsored by the Ialomita County Council.

Description: USAID focuses on the development and strengthening of a broad range of Romanian public policy oriented NGOs in four priority sectors: (1) democracy; (2) environment; (3) economic growth, and (4) social safety nets.Through subgrants and technical assistance, local NGOs are helped to become self-sustaining and capable of: influencing the formulation and implementation of public policy; serving as a forum for public policy debate and advocacy; mobilizing private resources; forming partnerships and alliances with appropriate public and/or private organizations; raising funds to further the purpose of the NGO and secure its financial and organizational sustainability; operating democratically, effectively, efficiently and responsibly; providing services to and advocacy for their constituents.

The Public Administration Program focuses on economic development, public management and public participation. It provides for short term advisors in each of these areas to concentrate activities on each of five pilot cities, the successful projects from each to be transferred to five additional Romanian cities. The public participation focus of the program will encourage non government and citizens organizations and individual citizens to participate in local government decision making and to encourage local authorities to make effective use of citizens. Among the few permitted activities of local government is local economic development. As citizens become more involved in government, they will become equally involved in economic decision making as well.

Host Country and Other Donors: EU-PHARE, EBRD, International Monetary Fund (IMF), the Soros Foundation, National Democratic Institute (NDI), International Republican Institute (IRI), and some individual European countries have programs which address this objective. Romanian communities receiving USAID assistance are not the beneficiaries of programs of other donors offering similar assistance. The Government of Romania does not provide matching funds or in-kind support for NGO development programs. Public Administration activities are largely supported by Romanian local government personnel and institutions. Individual NGO recipients also provide facilities and support with their own personnel.

Beneficiaries: The main beneficiaries of the "Democracy Network" program are citizen groups and local NGOs, who will improve their public advocacy methods and skills, as well as their institution-building capabilities. Ultimately, this will make staff of indigenous NGOs gain credibility and government officials become aware of the value of dialogue, team work and participatory training as examples of democracy at work in meeting the social needs at the community level.

Public Administration beneficiaries include local authorities and the citizens they serve will benefit through improved services. Ultimately the central government will benefit through being able to turn over authority for essentially local activities to local authorities.

Principal Contractors, Grantees, or Agencies: USAID implements activities through a cooperative agreement with World Learning Inc., in collaboration with the National Democratic Institute for International Affairs (NDI), and Support Center International (SCI). National Forum Foundation (NFF) and International Center for Not-for-profit Law (ICNL) are also involved in the program, as regional contractors.

This objective is supported by a contract with Chemonics, Inc. for the Public Administration Program for Romania.

Major Results Indicators*:

Number of new federations, organizations, coalitions, etc. formed to promote or oppose specific policies or legislation.
Rating of elections as free and fair by local and international monitors

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: Legal systems that better support democratic processes and market reforms.

Background: After December 1989, Romania had no laws safeguarding individual rights and delineating the limits of government power, nor regulations promoting the formation and development of a competitive and efficient market.

USAID Role and Achievements to Date: USAID's "Rule of Law" program offered technical assistance to the School of Magistrates, comments on draft laws, and seminars for young magistrates and lawyers. In 1995, a particular emphasis was on Romania's business-related body of law, covering intellectual property protection, bankruptcy, managing a private law practice and international joint ventures. Direct financial support was provided to the Bucharest Young Lawyers' Association to help it become self-sustaining. USAID worked to strengthening of the legislative branch of the government, which is still relatively weak compared to the executive branch. The FROST program to train parliamentarians and provide greater access to library material was initiated in August 1995 and will end in December 1996.

Description: USAID focuses its activities on: (1) creating an independent judiciary, free of interference from other branches of government; (2) creating a more coherent and rational commercial framework, which includes giving the Romanian Bar and judiciary a deeper understanding of commercial law; (3) activities to enable lawyers to exercise independent initiative in the development and implementation of legal principles and the protection of individual rights; (4) enabling law school graduates to better understand and appreciate the importance of legal skills in a system based on the rule of law; (5) strengthening parliament's capacity to pass high quality legislation.

Host Country and Other Donors: Ongoing efforts in legal system reform are coordinated with those of other donors, including EU-Phare, and the British Know-How Fund.

Beneficiaries: The main beneficiaries of the "Rule of Law" program are members of Romanian Magistrates Association, Bucharest Young Lawyers' Association, Romanian Bar Association, and law school graduates. The Romanian business community will benefit as improvements in corporate governance are implemented. Enabling parliament members to reference similar laws and undertake a critical analysis of draft legislation will help to ensure uniform and timely enforcement of laws.

Principal Contractors, Grantees, or Agencies: USAID implements activities through a grant to the American Bar Association, and an interagency agreement with the Congressional Research Service.

Major Results Indicators*:

Targeted laws are available to judges, court officials and the public, updated and published in a timely manner

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: More Effective, Responsive, and Accountable Local Governments.

Background: Romania is a unitary state and it has little experience with decentralized governmental authority. Decisions are made and control is exercised by the central government in Bucharest. Local authorities have restricted legal authority and even that authority is limited by central government control over the financial resources necessary to exercise even the limited authority the law provides.
USAID Role and Achievements to Date: USAID has provided assistance to several Romanian cities in housing privatization and management through creation of condominium associations, and in systems management for those same cities with emphasis on budget and financial management with the computerization necessary to support those systems. Two cities have been assisted in qualification for European Bank for Reconstruction and Development loans to correct deficiencies in their water and waste water systems. So far six cities have received technical assistance in budget and finance, the creation of modern program budgets, or computerization. Two of these cities have been approved for international assistance for their water utilities. The Romania Public Administration Program, underway only since October, 1995, has already produced an operating public participation citizens center in Slobozia, one of its pilot cities. As a result of the condominium project, a portion of the new housing law currently under consideration would not only provide for the existence of condominium associations but would require their creation as replacements for tenant associations for privately owned apartments.

Description: Expanding the condominium activity, a local capability to create and train condominium associations will be produced to cope with the national demand expected to be produced with the passage of the new condominium law now under consideration. The Romania Public Administration Program will encourage decentralization of power to local authorities by increasing the capacity and capability of local governments to perform those responsibilities the law now charges them with. Among those responsibilities is economic development, and the program will focus on economic assessments of each pilot city and the production of development plans for each. To combat the tendency to look to the central government for solutions, the public participation focus of the program will encourage non government and citizens organizations to participate in local authority decision making and to encourage local authorities to make effective use of citizens. The program will work initially in five pilot cities, and will expand to five more. The initial five will be charged with transferring lessons learned to the second five and the ten will then be the basis for spreading the benefits of the program throughout Romania.

Host Country and Other Donors: EU-PHARE, European Bank for Reconstruction and Development (EBRD), International Monetary Fund (IMF), the Soros Foundation, National Democratic Institute (NDI), and some individual European countries, notably the United Kingdom and Denmark sponsor programs that directly or indirectly impact this objective. Public Administration Program pilot cities do not receive similar assistance from other donors. Individual recipient cities provide facilities and support with their own personnel.

Beneficiaries: Through the process of spreading the results of successful programs in pilot cities, all local authorities in Romania will benefit. The citizens will benefit through improved services. Ultimately the central government will benefit through being able to turn over authority for local activities to local authorities.

Principal Contractors, Grantees or Agencies: This objective is supported by contracts with Chemonics Inc. for the Public Administration Program, with ICMA for the Local Government Assistance Program, and with NDI and IRI for programs which indirectly affect it.

Major Results Indicators*:

Percent of national revenue flowing to local governments
Passage of legal, fiscal and procurement reforms that empower local governments
Percent of local population that believes management and delivery of services at municipal level are either: improved, more cost effective or responsive.

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: Individuals Receive More Effective and Sustainable Health Services and Benefits

Background: Romania has one of the highest maternal mortality and infant mortality rates in Europe as well as a high number of institutionalized children. A major contributing factor is the lack of access to and use of modern contraceptives, resulting in unplanned pregnancies and subsequent high rates of abortion and child abandonment.

In addition, Romanian health care institutions have limited quality assurance systems and prevention programs in place, which has resulted in high rates of infectious diseases, such as HIV/AIDs and Hepatitis B and high rates of cardiovascular disease. There is an over-reliance on more costly hospital and specialist care in comparison to primary health care. Managers of the health care institutions are physicians who do not have skills in basic management, which has resulted in less effective and efficient use of the limited health resources.

Health reform is being piloted and evaluated in eight counties, a health insurance law has been introduced, and there is a draft health sector reform strategy. Major barriers to reform efforts identified by the World Bank and the government include lack of management training and lack of experience in implementing a new health delivery system.

USAID Role and Achievements to Date: Modeling prevention, community-based services, primary health care, and sound management practices has been a major focus for the last five years.

Community-based approaches to care of Romania's institutionalized children have been successfully demonstrated in ten counties. Social workers and educators have been trained and are working in collaboration with staff in government institutions to demonstrate services to prevent abandonment; facilitate family reintegration, domestic adoption and foster care; or improve the social and living skills for children and young adults. Government officials are starting to implement similar programs in other counties. Romanian social workers and managers trained though these projects are now taking a leadership role in addressing child welfare issues. National and local groups have been created to advocate for children's rights and to promote improvements in child welfare legislation and administrative policies.

Family planning services have been developed and seven clinics have provided high quality services and education, which have served over 27,000 women to date. The Ministry of Health is now utilizing staff trained by the program to train government family planning providers. Family planning managers are being trained in contraceptive logistics management.

A primary health care curriculum has been developed and approved by the Ministry of Education. More than 3,700 students, residents and general practitioners will be trained each year in primary
health care at the Medical school in Cluj. Concepts of primary health care will be introduced to schools of dentistry and pharmacy.

Six new-born protocols are in place in 12 maternities and will be introduced in another 40 hospitals impacting 80% of all mothers and newborns. Safe and effective hepatitis B vaccines are now being given to all newborns whom are born in maternities. Over 17,000 workers have been screened for cardiovascular risk; those at risk will receive prevention education and follow-up screening.

An early childhood development program has resulted in the development of a national curriculum that has been implemented at 20 government sites.

Health management technical assistance and training has focused on introducing to health managers and providersin the health reform districts concepts of quality assurance, practice management, and methods for determining costs and performance. The program facilitated the creation of work groups of general practitioners and specialists in two reform districts that are now developing practice protocols and standards to improve quality of care and have implemented procedures to increase client access to care.

Description: Through the United Nations Children's Fund (UNICEF), the program will continue to promote the sustainability of community based care for children by educating policy makers about the achievements of the projects.

Seven USAID funded family planning clinics will implement sustainability plans. To increase access to modern contraceptives, private pharmacists will be trained in contraceptive marketing and operations management. The program will continue activities to help create a policy environment supportive of women's and children's health.

A health management training partnership will build upon program activities initiated to date and on a World Bank management training program. The partnership will strengthen the knowledge and skills of the health management training staff and health managers in the field by assessing and improving the health management curriculum The program will facilitate linkages between health management training and practical application in the context of health reform implementation, through the development of case studies. The program will also facilitate information sharing and problem solving across reform districts and with other Central and East European countries implementing health reform.

Host Country and Other Donors: On going efforts related to women's and children's health are coordinated with those of other donors, including UNICEF, United Nations Fund for Population Activities (UNFPA), EU PHARE (Child Protection Program), and the World Bank. USAID is represented on the National Committee for the Protection of Children, which has developed a National Action Plan for child protection. The Ministry of Health is beginning to provide family planning services around the country and to provide training to about 400 general practitioners and obstetical nurses.

Efforts related to health system reform are coordinated with the World Bank and EU Phare. The World Bank has been the major donor in the health sector, providing loans for primary health care, family planning clinics, and a health management training institute. The Ministry of Health has initiated several laws related to health reform, has taken the initiative on developing a cost model, is implementing health reform in eight counties, and supports (through the World Bank loan) the Institute of Hygiene, Public Health and Health Services and Management (IIPSSC). The IIPSSC staff is responsible for health management training and technical assistance to the reform districts.

Beneficiaries: All Romanians will eventually be impacted by health reform efforts. Women of reproductive age and children account for 40% of the population in Romania, or about nine million people. USAID-supported program reach about one-one half of these beneficiaries.

Principal Contractors, Grantees, or Agencies: USAID implements activities through U.S. PVOs, local NGOs U.S. firms and U.S. universities including: Feed the Children, Holt International Children's Services, Project Concern International and World Vision.

Major Results Indicators*:

Improved treatment for cardio-vascular disease (leading cause of death) results in decrease in
mortality rate
Reduced child mortality rates
Increased use of modern contraceptives and decline in unwanted pregnancies
Improved health management practices
Increased use of primary health care

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country-specific indicators and targets, which will be completed by June 1996.

Purpose: Reduced environmental risk to public health

Background: USAID environmental health activities address three areas: 1) the reduction of exposure to toxic pollution at selected industrial sites; 2) improving environmental policies and institutions and; 3) using economic incentives to obtain better environmental outcomes.

1) The town of Zlatna is one of 14 environmental "hot spots" in Romania. The major health problems in the area are caused by exposure to lead and Sulfur dioxide. Lead in the environment comes from traditional mining and copper smelting activities that existed in the area for the last 250 years. Sulfur dioxide is emitted by AMPELLUM Copper Smelter during its operation.

2) EAPS activities in Romania are being implemented pursuant to the U.S. Government commitments under the Environmental Action Program which was adopted in Lucerne in 1993. Following GOR requests, and in support of the EHP1, EAPS focusses on Technical Assistance and equipment provision to the AMPELLUM Copper Smelter.

3) Due to the need to create and improve a environmental policy, and a legal and regulatory framework, at the request of the Council for Coordination, Strategy and Economic Reform, USAID, through HIID, began to grant long and short term technical assistance to the GOR, namely Ministry of Waters, Forests and Environmental Protection, Ministry of Industries, Parliament, National Commission for Statistics, and municipalities.

USAID Role and Achievements to Date: Romanian Working Groups for all three major activities have greatly assisted EHP team members in identifying equipment and TA needs. Locally designed, family and community health education/ counselling materials and programs to reduce exposure of children to lead were drafted and distributed. More than 300 children were tested for their blood lead levels; as a consequence, more than 150 families received counselling from the local medical staff. Data reveal that no child under 11 had a level of 10mcg/dl, the CDC's "level of concern". A Workshop on Data Analysis, Interpretation and Communication increased the capability to approach in a holistic way the different kinds of data made available during the project, in order to find concrete ways to reduce health hazards for population. The Medical Research Center in Cluj Napoca is better able to perform blood lead level tests.

The EAPS initiated activities in Romania in 1995, working with AMPELLUM on smelter technological information, operation, management, and financial support for equipment purchases and design assistance. The EAPS project also supported a Study Tour in December 1995 of US Copper Smelter.

Assistance with the Water Law, in recommending the "beneficiary-pays" principle, the establishment of the local level River Basin Commissions, and explicit and mandatory public participation in the water management. At the suggestion of the USAID program, an interministerial task force to ensure the expeditious implementation of the Environmental Law was established. In the forestry sector, the Project has designed procedures for the Forestry Dept to improve timber auction to help them obtain a fair market value for the timber. To date, the program has also completed a contingent valuation survey/willingness-to-pay analysis which will form the basis of upcoming policy recommendations. A methodology has been provided to the National Statistics Commission to a compute a NNP series incorporating resource depletion. This will allow the GOR to set targets and indicators regarding the true sustainability of investment and consumption allocation decisions.

Description: At the request of the GOR, USAID selected Zlatna as a demonstration site for reducing the environmental risk to population. USAID requested the Environmental Health Project (EHP) to provide AMPELLUM and various community groups in Zlatna with both technical and equipment assistance to reduce the environmental and human health problems associated with the smelter. At the request of USAID, EHP addressed the following three areas ofconcern in Zlatna and the surrounding county of Alba: reducing the exposure of young children to lead; air quality monitoring and control; and occupational health and safety. There is a clear need to consolidate these gains, as well as to attempt to replicate this model with other communities in Romania facing similar environmental and occupational problems.

Depending on available funding, the EAPS program will provide to selected project sites a combination of three types of support (1) TA aimed at improving process efficiency, (2) grant procurement of equipment and instrumentation that significantly reduces environmental emissions, and (3) training focussing on building the technical capacity and environmental awareness in the non-ferrous metals industry.

The Project is designed to: analyze existing policies, laws and regulations, to determine their impact on environment and major environmental hazards and their causes; identify least-cost policies and their concrete solutions to deliver affordable environmental protection during transition to a market economy; develop strategies, legislation, regulations and methodologies in support of sustainable economic development; transfer skills in environmental economics and policy analysis.

Host Country and Other Donors: The Government of Romania disbursed the equivalent of $1,000,000 up to the end of 1995 for retrofitting the AMPELLUM Copper Smelter. Proposals have been made to allocate the equivalent of $1,500,000 from the FY 1996 State Budget for the same purpose.

Beneficiaries: Local communities, EPAs, industries in selected sites,: central and local GOR and municipalities.

Principal Contractors, Grantees and Agencies: Camp Dresser and McKee (EHP), Chemonics (EAPS), World Environment Center.

Major Results Indicators*:

Average blood lead levels reduced in targeted areas
Substantially reduced emissions of airborne pollution, especially metal oxides, other particulate, and Sulfur dioxide in targeted areas
Improved management capacity to plan and manage operations in accordance with Western standards and practices through training, workshops, and tours of US industries
GOR develops strategy to implement environmental liability provisions mandated by the environmental law

*These are illustrative indicators. ENI missions are in the midst of the complex process of developing meaningful, measurable country- specific indicators and targets, which will be completed by June 1996.